50% cesarean rate in Canada can't be ruled out, says Dr

I recently came across a September 2008 article on the Vancouver Sun's website, 'Canada's caesarean capital' (a report by Katherine Dedyna on the country's 26% cesarean rate), in which Dr. Jerome Dansereau, chief of obstetrics at the Vancouver Island Health Authority, says he "doesn't rule out the rate going to 50 per cent, given the continuing upward swing. "There is no one who could have predicted what we see today," he says, "and there is no one who can predict when it will stop.""

In the same article, midwife Lyons Richardson says she "won't be surprised if eventually women walk in cold with their first pregnancy and demand a C-section for any reason they want. "Give it 10 years and I don't think it's going to be that unusual.""

Victoria General Hospital is reported to have the highest rate in the country at 37%, and some of the reasons cited by doctors for this are: "older, heavier mothers; increasing numbers of women who don't want to labour long; technology that shows potential fetal problems; mothers who have had previous C-sections returning for a second; and the presence of worried fathers in the labour room."

Luba Lyons Richardson, vice-chairwoman of midwifery at VGH, remarks on a "culture shift in her 30 years of practice. "Women themselves have less tolerance for longer labours, for a baby that's a little bit in distress." ...She knows of women who ask for elective caesarean sections and get them, depending on extenuating circumstances. "That's another debate that rages on. If women have choice, then shouldn't they have that choice?""

Also of interest in the article: "Surgeons in Victoria will do C-sections rather than traumatic forceps delivery. Only 10 per cent or fewer of VGH births involve instruments such as forceps, far lower than the national average of 16 per cent."

The doctors cited in this report do not necessarily agree with prophylactic cesarean delivery with no medical indication, but it is clear that they do not expect to see Canada's cesarean rate being reduced to the WHO's controversial recommendation of 10-15% any time soon.